We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

When Does Diabetes Start?

Christopher D. Saudek, MD
JAMA. 1990;263(21):2934. doi:10.1001/jama.1990.03440210084039.
Text Size: A A A
Published online


Diabetes causes multiple metabolic defects, and its complications attack multiple organ systems. But it is frustratingly difficult to pin down a specific link between these metabolic derangements and long-term complications. The venerable "control and complications controversy" persists because we keep looking for one answer, one simple relationship between glycemic control and diabetic complications. But why should the relationship be simple or linear? Why should the product of blood glucose and time necessarily cause, equally, such diverse end-organ damage as neuropathy, nephropathy, retinopathy, and accelerated atherosclerosis? Factors other than blood glucose are almost certainly involved.

It should not be surprising, then, that obesity, blood pressure, high serum lipid levels, and family history play a significant role in macrovascular complications. Coexisting risk factors are especially relevant in type II, non—insulin-dependent diabetes, because this disease confers the most risk for accelerated atherosclerosis and the risk is most difficult to correlate specifically with glycemia.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.